Diagnostic value of pulmonary ultrasound in acute exacerbation of chronic obstructive pulmonary disease: A pilot study

Background: To evaluate the value of the pulmonary ultrasound for the diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in emergency departments (EDs).Materials and methodsBetween January 2018 and December 2019, patients admitted to the ED of Shanxi Provincial People's Hospital for suspected AECOPD were prospectively included in this study. Pulmonary ultrasound was performed using a linear transducer. The pulmonary ultrasound findings were evaluated for further discrimination for patients with AECOPD. Then, the diagnostic performance of pulmonary ultrasound was estimated and calculated. The clinical characteristics between groups with and without pneumonia were compared.ResultsA total of 53 patients with AECOPD were included in the final analysis. For diagnosis of AECOPD due to pneumonia, ultrasound findings, such as consolidation, slightly rough pleural line, or irregular and interrupted pleural line had a sensitivity of 92.3% and a specificity of 86.7%. For diagnosis of AECOPD complicating pulmonary fibrosis, fringed pleural line had a sensitivity of 100% and a specificity of 97.5%. In addition, patients with pleural effusion (n=19) or pneumothorax (n=1) were correctly identified and wavy or bulging pleural lines were common in patients with AECOPD (58.5%, 31/53).ConclusionUltrasound findings could offer further discrimination for AECOPD complications and other pathological conditions, such as pneumonia, pulmonary fibrosis, pleural effusion, and pneumothorax in EDs. (AU)

Fundamento: Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) a menudo acuden al servicio de urgencias por una exacerbación de su enfermedad que requiere una actuación inmediata. Por consiguiente, es fundamental llevar a cabo un diagnóstico rápido de su proceso crónico. El objetivo de este estudio fue evaluar el valor de la ecografía pulmonar en el diagnóstico de exacerbación aguda de la EPOC (EAEPOC) en el servicio de urgencias.Materiales y métodosDe enero de 2018 a diciembre de 2019 se incluyeron prospectivamente pacientes sospechosos de EAEPOC en el Servicio de Urgencias del Hospital popular de Shanxi. Se utilizó un transductor lineal para llevar a cabo la ecografía pulmonar. Los resultados de la ecografía pulmonar se utilizaron para diferenciar a los pacientes con EAEPOC y se evaluó el rendimiento diagnóstico de esta técnica. Se compararon las características clínicas del grupo con neumonía con las del grupo sin neumonía.ResultadosUn total de 53 pacientes con EPOC fueron incluidos en el análisis final. Para el diagnóstico de EAEPOC causada por neumonía la sensibilidad y especificidad de la ecografía fueron 92,3% y 86,7%, respectivamente. La sensibilidad y especificidad de la línea pleural marginal en el diagnóstico de EAEPOC con fibrosis pulmonar fueron del 100% y 97,5%. Además, los pacientes con derrame pleural (n=19) o neumotórax (n=1) fueron identificados correctamente, y las líneas pleurales onduladas o elevadas fueron frecuentes en los pacientes con EAEPOC (58,5%; 31/53).ConclusiónLa ecografía puede diferenciar las complicaciones de la EAEPOC de otras condiciones patológicas como neumonía, fibrosis pulmonar, derrame pleural y neumotórax. (AU)

The clinical application of sound touch elastography in acupuncture treatment of stroke patients with upper limb spasm / 中华超声影像学杂志

Objective:To explore the clinical application value of sound touch elastography (STE) in the evaluation of the curative effect of acupuncture and moxibustion in the treatment of stroke patients with upper limb spasm.Methods:Fifty-five patients with upper limb spasm after stroke were selected as stroke group, and thirty healthy volunteers matched with age, gender and body mass index (BMI) were selected as control group between September 2020 and March 2021. The shear wave velocity (SWV) of biceps brachii and triceps brachii were measured in both groups. In stroke group, the SWVs of biceps brachii and triceps brachii on spastic side and non-spastic side were measured before and after acupuncture treatment, and the correlations between SWV and spastic grade (X), muscle response angle (R1), passive range of motion (R2), spastic angle (R2-R1) of modified Tardieu scale (MTS) were analyzed.Results:At 0 degree, the SWV of spastic biceps brachii (3.85±0.62)m/s was significantly higher than those of the non-spastic side [(3.34±0.35)m/s] and control group [(3.15±2.66)m/s] (all P<0.001), and decreased [ (3.45±0.47)m/s] after acupuncture treatment ( P<0.001). At 90 degree, the SWV of non-spastic biceps brachii was larger than those of spastic side and control group [1.98(1.92, 2.14)m/s vs 1.98(1.92, 2.11) m/s, 1.95(1.86, 2.05)m/s, all P<0.05], and there was no significant difference between the SWV of spastic side and control group ( P>0.05). There were no significant differences in SWV of triceps brachii between the spastic side and control group at both 0 degree or 90 degree ( P>0.05). At 0 degree, SWV positively correlated with MTS (x) ( rs=0.639, P<0.001) and negatively with R1 ( rs=-0.527, P<0.001) and R2 ( rs=-0.825, P<0.001) on the spastic biceps brachii. Conclusions:STE can provide quantitative index for the objective evaluation of the curative effect of acupuncture in upper limb spasm after stroke, and it is proposed to be an effective means of clinical diagnosis and efficacy evaluation in patients with upper limb spasm after stroke.

Application value of sound touch quantification in screening high risk group of non-alcoholic steatohepatitis / 中华超声影像学杂志

Objective:To investigate the application value of sound touch quantification (STQ) in screening high risk group of non-alcoholic steatohepatitis(NASH).Methods:From February 2019 to January 2020, 98 patients with non-alcoholic fatty liver disease(NAFLD) and 36 healthy volunteers were included in this study. NAFLD patients were divided into NASH high risk group and NASH low risk group. The liver Young′s modulus were measured by STQ and compared among the three groups. The ROC curve was used to analyze the effectiveness of STQ in screening NASH high risk population. When the maximum value of Jordan index was selected, the best boundary threshold was selected to analyze its sensitivity, specificity and accuracy. Liver biopsy was performed in 15 patients with abnormal liver function as validation group.Results:There were significant differences in the mean values of Young′s modulus among high risk group, low risk group and control group ( F=33.068, P<0.01). The Young′s modulus of NASH high risk group was significantly higher than those in NASH low risk group and control group ( P<0.05). The Young′s modulus between NASH Low risk group and control group was not significantly different( P=0.443). The best screening threshold was 6.46 kPa, the sensitivity was 89.2%, the specificity was 85.2%, and the accuracy was 88.6%. In the verification group, when the Young′s modulus≥6.46 kPa, the accuracy was 73.3%, the sensitivity was 75.0%, and the specificity was 66.7%. Conclusions:As a screening index, STQ elastic imaging technology has certain value in screening NASH high risk group.